Joints

What a joint is

A joint is an assembly rather than a single structure. The ends of the bones are capped with articular cartilage, a smooth layer that lets them glide with little friction. Around them is a capsule lined with synovium, a thin membrane producing the fluid that lubricates and nourishes the surfaces. Ligaments limit motion to the directions the joint is built for, and tendons carry the pull of muscles across it. Some joints contain extra pieces for their particular job: the menisci that cushion the knee, and the labrum that extends the rim of the socket in the hip and shoulder.

Because these parts work together, trouble in one tends to affect the others. A torn ligament that leaves a joint unstable exposes the cartilage to abnormal shear. A joint that hurts is used less, the muscles around it weaken, and it loses the support they provide. This is why an assessment examines a joint as a whole system, and often the joints above and below it.

The major joints Dr. Wolfson treats

• Hip. A deep ball and socket built for stability under load. See hip arthritis.
• Knee. The largest joint in the body, depending on ligaments and menisci for stability. See knee arthritis.
• Shoulder. The most mobile joint, held centered by the rotator cuff. See shoulder arthritis.
• Elbow. Three joint surfaces in one capsule, providing bending and forearm rotation. See elbow arthritis.
• Foot and ankle. A chain of joints that absorb impact and form a lever for push off. See foot and ankle arthritis.

Symptoms that often bring people in

• Pain in or around a joint provoked by particular movements or by weight bearing.
• Swelling, warmth or a joint that feels full and tight.
• Stiffness and loss of the range of motion the joint used to have.
• Grinding, clicking, catching or a joint that locks.
• A sense of giving way, weakness, or a change in the alignment of a limb.

How joint problems are evaluated

Assessment starts with the story of the joint: whether the trouble began with an injury or came on gradually, and what you can no longer do. Examination compares both sides, measures range of motion actively and passively, tests strength and stability, and looks at the alignment of the limb while standing and walking. X-rays show bone, joint space and alignment, and are usually taken weight bearing for the hip, knee, foot and ankle. MRI shows cartilage, ligaments, menisci and tendon, while CT gives detailed bone anatomy. Where inflammatory disease is suspected, blood tests and referral to a rheumatologist may form part of the plan.

Treatment options in general terms

Treatment spans a wide range, and the aim is to use the least invasive approach that addresses the actual problem.

• Rehabilitation and load management. Physical therapy, activity adjustment and conditioning to support a joint with the muscles around it.
• Bracing and orthoses. Devices that improve stability or shift load away from a damaged part of a joint.
• Medication and injections. Anti-inflammatory categories, corticosteroid injection, hyaluronic acid substitutes, and biologic options such as platelet rich plasma.

When these are not enough, surgical options exist across a spectrum from preserving a joint to replacing it.

• Arthroscopic and minimally invasive surgery. Addressing loose fragments, torn menisci, inflamed lining and impinging spurs through small incisions.
• Joint preservation. Procedures intended to protect a joint that still has usable cartilage, including realignment of bone and cartilage restoration.
• Joint replacement. Resurfacing worn surfaces with implants, partial or total depending on how much of the joint is involved.
• Revision surgery. Reconstruction when a previous replacement or repair must be addressed again.

What to expect when you consult Dr. Wolfson

Dr. Nikolaj Wolfson, MD, FRCSC, FACS, is board certified in the United States and Canada and treats joint problems across the upper and lower limb. A consultation is built around what the joint stops you doing, followed by examination, imaging and a plain explanation of the findings.

This page provides general information about joints and joint conditions and is not medical advice. It is not a substitute for examination, imaging and diagnosis by a qualified physician. Every case is different and requires individual evaluation. If you have severe pain, an obvious deformity, loss of function, fever, or an injury from a significant accident, seek medical care promptly.

Contact Dr. Wolfson if you would like to setup an appointment. If you are a new patient, please book all in-person appointments with Dr. Wolfson via telephone.

If you live outside of the San Francisco Bay Area, you can request a complimentary phone consultation with Dr. Wolfson to assess your case. Please call or e-mail us to set up your complimentary consultation.

Call: (415) 221-4400

E-mail: [email protected]